From the Research
Ankle joint steroid/lidocaine injections should be performed using a mixture of a corticosteroid (typically 40mg methylprednisolone or 20-40mg triamcinolone acetonide) with 2-3ml of 1% lidocaine, with a total injection volume not exceeding 5ml to prevent capsular damage from overdistension, as supported by the most recent evidence 1.
Key Considerations
- The procedure requires sterile technique with skin preparation using chlorhexidine or povidone-iodine solution.
- The most common approach is the anteromedial portal, with the patient's ankle dorsiflexed and the needle inserted between the tibialis anterior and medial malleolus tendons, directed toward the center of the joint at a 45-degree angle.
- Alternatively, the anterolateral approach can be used between the lateral malleolus and peroneus tertius tendon.
- Aspirate before injecting to ensure proper placement and avoid vascular injection.
Post-Injection Care
- Post-injection, patients should rest the joint for 24-48 hours and avoid strenuous activity for 1-2 weeks.
- These injections provide anti-inflammatory effects and pain relief for conditions like osteoarthritis, rheumatoid arthritis, and synovitis.
Limitations and Contraindications
- The injections should be limited to 3-4 injections per year in the same joint to prevent cartilage damage, as recurrent injections have been shown to provide inferior symptom relief compared to other injectables at 3 months and beyond 1.
- Contraindications include active infection, significant skin disease at the injection site, uncontrolled diabetes, and known hypersensitivity to the medications used.
Adverse Events
- The adverse event rate following intra-articular ankle or subtalar joint corticosteroid injection was 5.8%, with postinjection flare being the most common complication, as reported in a retrospective comparative study 2.
- No infections were noted in this study, but other adverse events such as skin reactions and postinjection flare can occur.